Healthcare Provider Details

I. General information

NPI: 1528127966
Provider Name (Legal Business Name): TERI DOYLE CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 SAINT MICHAELS DR STE B104
SANTA FE NM
87505-7671
US

IV. Provider business mailing address

435 SAINT MICHAELS DR STE B104
SANTA FE NM
87505-7671
US

V. Phone/Fax

Practice location:
  • Phone: 505-992-3334
  • Fax: 505-992-1998
Mailing address:
  • Phone: 505-992-3334
  • Fax: 505-992-1998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberR49108
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: